Provider Demographics
NPI:1386999514
Name:SOULE, KAITLIN ELIZABETH (LMFT)
Entity type:Individual
Prefix:MISS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:SOULE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 AARON CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3881
Mailing Address - Country:US
Mailing Address - Phone:707-291-6118
Mailing Address - Fax:
Practice Address - Street 1:755 BAYWOOD DR STE 254
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5508
Practice Address - Country:US
Practice Address - Phone:707-658-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALMFT93947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program